Abstract
BackgroundHealth insurance contributes to reducing the economic burden of disease and improving access to healthcare. In 2016, the Chinese government announced the integration of the New Cooperative Medical Scheme (NCMS) and Urban Resident Basic Medical Insurance (URBMI) to reduce system segmentation. Nevertheless, it was unclear whether there would be any geographic variation in health insurance benefits if the two types of insurance were integrated. The aim of this study was to identify the potential geographic variation in health insurance benefits and the related contributing factors.MethodsThis cross-sectional study was carried out in Qianjiang District, where the NCMS and URBMI were integrated into Urban and Rural Resident Basic Medical Insurance Scheme (URRBMI) in 2010. All beneficiaries under the URRBMI were hospitalized at least once in 2013, totaling 445,254 persons and 65,877 person-times, were included in this study. Town-level data on health insurance benefits, healthcare utilization, and socioeconomic and geographical characteristics were collected through health insurance system, self-report questionnaires, and the 2014 Statistical Yearbook of Qianjiang District. A simplified Theil index at town level was calculated to measure geographic variation in health insurance benefits. Colored maps were created to visualize the variation in geographic distribution of benefits. The effects of healthcare utilization and socioeconomic and geographical characteristics on geographic variation in health insurance benefits were estimated with a multiple linear regression analysis.ResultsDifferent Theil index values were calculated for different towns, and the Theil index values for compensation by person-times and amount were 2.5028 and 1.8394 in primary healthcare institutions and 1.1466 and 0.9204 in secondary healthcare institutions. Healthcare-seeking behavior and economic factors were positively associated with health insurance benefits in compensation by person-times significantly, meanwhile, geographical accessibility and economic factors had positive effects (p < 0.05).ConclusionsThe geographic variation in health insurance benefits widely existed in Qianjiang District and the distribution of health insurance benefits for insured inpatients in primary healthcare institutions was distinctly different from that in secondary healthcare institutions. When combining the NRCM and URMIS in China, the geographical accessibility, healthcare-seeking behavior and economic factors required significant attention.
Highlights
Health insurance contributes to reducing the economic burden of disease and improving access to healthcare
Segmentation has been severe for a long time among New Cooperative Medical Scheme (NCMS), Urban Resident Basic Medical Insurance (URBMI), and Urban Employee Basic Medical Insurance (UEBMI) which cover different population groups
The variation resulted from hospitalization between primary healthcare institutions and secondary healthcare institutions were much more severe, Theil index values for compensation by person-times and amount were 2.5028 and 1.8394 in primary healthcare institutions, and 1.1466 and 0.9204 in secondary healthcare institutions
Summary
Health insurance contributes to reducing the economic burden of disease and improving access to healthcare. In 2016, the Chinese government announced the integration of the New Cooperative Medical Scheme (NCMS) and Urban Resident Basic Medical Insurance (URBMI) to reduce system segmentation It was unclear whether there would be any geographic variation in health insurance benefits if the two types of insurance were integrated. Segmentation has been severe for a long time among New Cooperative Medical Scheme (NCMS), Urban Resident Basic Medical Insurance (URBMI), and Urban Employee Basic Medical Insurance (UEBMI) which cover different population groups. These three identity-based, district-varied health schemes have led to rural-urban variation in health insurance and have affected access to healthcare [7]. Considering the serious segmentation of the health insurance system and in order to improve the equity, sustainability and efficiency of NCMS and URBMI, the decision to integrate the NCMS and URBMI was announced in China in 2016 [9]
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